K. R. McMahon1, C. Cordero-Caballero1, A. Afzali3, S. Husain2 1The Ohio State University Wexner Medical Center,College Of Medicine,Columbus, OHIO, USA 2The Ohio State University Wexner Medical Center,Division Of Colon & Rectal Surgery,Columbus, OHIO, USA 3The Ohio State University Wexner Medical Center,Division Of Gastroenterology, Hepatology, And Nutrition,COLUMBUS, OHIO, USA
Introduction: Gastroenterologists commonly use the Harvey-Bradshaw Index (HBI) to assess the severity of Crohn’s disease (CD) and to guide medical therapy. Surgeons, on the other hand, often use the ACS NSQIP Surgical Risk Calculator to determine surgical risk when treating patients with CD. However, the ACS NSQIP calculator does not account for CD as a risk factor even though it has been shown to be an independent predictor of poor postoperative outcomes. The utility of the HBI to predict surgical complications has not been studied. The aim of our study was to compare the ability of HBI and ACS NSQIP Surgical Risk Calculator to predict surgical complications in patients with Crohn’s disease. We hypothesized that HBI is a superior method of predicting surgical complications in this patient population.
Methods: A retrospective chart review was done to identify patients who underwent surgery for CD and the post-operative complications. Patients who had an HBI calculated prior to, but within one month of surgery, were identified. The ACS NSQIP Surgical Risk Calculator was used to calculate each patient's predicted risk. The group was divided into high and low risk based on the calculator’s listed probability for any complication. Patients were also divided into a low disease activity and high disease activity based on their HBI. Fisher’s exact test, unpaired t-test, and chi-square distribution were used for statistical analysis.
Results:
A total of 61 patients were included. The average age was 37 years old. 40% were male and 60% female. The overall complication rate was 33%.
There was no significant difference between the high disease activity and low disease activity HBI groups in age, gender, ASA class, steroid use, or NSQIP calculated risk of any complication. There was no significant difference between the NSQIP calculated high and low-risk groups in age, gender, steroid use, or HBI. The higher risk group did correspond to a higher ASA class; this relationship achieved statistical significance (p=0.0113).
The high disease activity HBI group had significantly more surgical complications than the low disease activity group. Additionally, the high disease activity group also had a significantly longer length of hospital stay (table 1). There was no significant difference between the NSQIP calculated high and low-risk groups for surgical complications or length of hospital stay (table 1).
Conclusion: HBI score appears to be a better predictor of postoperative outcomes than the commonly used ACS NSQIP Surgical Risk Calculator. Further study is needed to examine the relationship between HBI and surgical risk prospectively and in a larger population of patients.
